Addressing the Challenges of Complex Pediatric
Illness
through Innovation and Compassion.
 Cancer | Heart | Neuroscience
Diagnostic
Services
• Blood tests – Blood tests can be helpful in determining
if a child has cancer. A complete blood count test, also known
as “CBC,” counts the three types of blood cells: white
blood cells, red blood cells and platelets. Doctors look for a
change in the number of white blood cells or lymphocytes, which
fight infection, red blood cells, which carry oxygen, and platelets,
which help the blood to clot. The CBC is very important when a
diagnosis is made because cancer can affect the amount of red
blood cells, white blood cells and platelets present before treatment
has begun. This blood test is also done after therapy has started.
Cancer treatments using chemotherapy and radiation therapy decrease
the number of red blood cells, white blood cells and platelets.
When the number of blood cells are decreased, the child will have
a “low blood count.” If the red blood count is low,
the child may become pale and tire easily. When the white blood
count or “white count” is low, the child is not able
to fight infection and is more susceptible to getting an infection
or cold. Finally, when the platelet count is low, the child may
have increased bleeding, as seen by nosebleeds or bruising.
•
Bone marrow aspiration or biopsy – Many forms of cancer
begin or spread to the bone marrow, which is liquid and looks
like blood. It is found inside some of the bones of the body.
Examining a sample of bone marrow under a microscope is the only
test that can confirm the presence of certain cancers such as
leukemia. A sample of bone marrow is usually removed, or “aspirated,” from
the hip bone through a special needle while the child lies on
his stomach or side.
•
Bone scan – This scan provides information about the bones
in the body. Before the scan can be done, the child will have
a radioactive material (isotope) injected intravenously. The child
will then be asked to drink a large volume of water (1 quart for
older children). This will help move the isotope in the blood
stream. The actual scan will not take place for 3 to 6 hours.
If a tumor has affected a bone, it will appear on the scan as
an area of increased update of the radioactive material.
•
Spinal tap or lumbar puncture – Cerebrospinal fluid (CSF)
surrounds the brain and spinal cord, and certain cancers are known
to spread to this fluid. A lumbar puncture, also called a spinal
tap, is performed while the child lies on his side with legs curled
up to the chest. A needle is placed between the small bones of
the back to collect the fluid, which is then checked for the presence
of cancer.
•
CT (computed tomography) scan – This is a diagnostic test
that uses special X-ray equipment to obtain cross-sectional pictures
of the body. CT gives the treatment team detailed images of organs,
bones and other tissues. CT is used in cancer diagnoses in several
ways: 1) to detect or confirm the presence of a tumor; 2) to provide
information about the size and location of the tumor and whether
it has spread; 3) to guide a biopsy (which is the removal of cells
or tissues for examination under a microscope); 4) to help plan
radiation therapy or surgery; and 5) to determine whether the
cancer is responding to treatment.
•
MRI (magnetic resonance imaging) – This is a diagnostic
test similar to a CT scan but which employs powerful magnets instead
of X-rays to create precise pictures of body tissues using radio
waves. These radio waves are not harmful to tissues, and the procedure
is painless. However, it may require sedation because the child
must remain absolutely still.
•
Ultrasound – This painless procedure uses sound waves to
examine internal body structures or tumors. The child likes down
and lotion is spread over the area to be scanned. A probe is then
rubbed over the area and a video image can be seen on a monitor.
•
Biopsy – Biopsies involve taking a sample of tissue, which
is then studied in the laboratory. In a needle biopsy, a tissue
sample is removed through a thin needle inserted into the tumor.
Sometimes, surgery is required to remove the tissue. This is called
an “excisional” or “incisions” biopsy,
and is usually performed in an operating room by either
surgeons or radiologists while the child is under general anesthesia.
•
Tumor markers – There are a number of laboratory tests
that measure the chemicals made by certain tumor cells. These
chemicals
are called tumor markers. Not all childhood cancers have
tumor markers. These tests are done at the time the child is
diagnosed
and will be repeated periodically, if positive, to determine
the response of the tumor to therapy.
•
EEG – An EEG, or electroencephalogram, is a recording of
the electrical waves in the brain. It measures electrical impulses
that are sent between nerve cells. This diagnostic device can
help doctors localize brain tumors and other lesions, and determine
whether cancer has spread to the brain. An EEG uses small electrodes
to measure the electrical activity within the brain. It does not
deliver any electricity of its own. The technician uses a paste
to attach 23 small electrodes to the person’s scalp. The
electrodes carry information about the brain’s electrical
activity to an amplifier. A special machine records the
amplified brain waves, and produces a pattern of tracings called
an electroencephalogram.
While EEG is primarily used to complement CT and MRI studies,
it provides the only continuous measure of cerebral function
over time.
•
Electrocardiogram (EKG) – This test evaluates the conduction
system of the heart. Small electrode patches are placed
on the chest, wrist and ankles. These are connected to a machine
that
traces the electrical activity of the heart.
•
Brainstem audio evoked response (BAER) – This test measures
hearing in children too young to cooperate for the audiogram.
Sedation is given and small electrodes are placed on the child’s
head and then connected to a machine. The child’s response
to sounds is then measured by the electrical impulses
recorded.
•
Pulmonary function test (PFT) – This is a group of tests
that measures breathing and lung function. Usually only
children old enough to cooperate with several instructions
can perform
these tests. These children are instructed to breathe
into a machine that measures the capacity of their lungs. Occasionally,
a small
blood sample is needed to complete this testing.
•
Audiogram – This test measures the child’s hearing.
During this test, the child wears earphones, and is asked to indicate
by raising his/her hand when he/she hears the tone. This tone
will vary in volume and sound frequency. The test is painless,
and takes only a few minutes to complete. It is necessary that
this test be performed in a room that is quiet. If there is too
much noise in the child’s hospital room, it may be necessary
to take the child to one of the treatment rooms where
it is quieter, in order to perform this test.
Medical Services and Treatment
After a diagnosis is made, family members meet with the oncologist
who will outline the child’s treatment plan. Treatment plans,
which are called protocols, are based on a variety of factors
including the type and extent of disease at diagnosis. A majority
of CHOC protocols come from the Children’s Cancer Group
(CCG), a national organization funded by the National Cancer Institute
(NCI). The goal of CCG is to improve the treatment and increase
the survival and cure rates of childhood cancer.
Different types of cancers call for one or more different treatment
approaches. Family members receive a “roadmap,” which
is the “calendar” of the treatment plan. The child’s
nurse reviews the roadmap with each family. It may also be modified
according to the child’s response.
Here is a brief overview of our medical services that may be
included in the roadmap:
• Chemotherapy – Chemotherapy is the treatment of
cancer with drugs that can destroy cancer cells. When cancer occurs,
cells in the body keep dividing and form more cells without control.
Chemotherapy destroys cancer cells by stopping them from growing
or multiplying. Healthy cells can also be harmed, especially those
that divide quickly. Harm to healthy cells is usually what causes
side effects, but they can usually repair themselves after chemotherapy.
Chemotherapy can be used in several different ways: 1) to cure
the cancer, 2) to control the cancer, 3) to relieve symptoms that
the cancer may cause.
•
Radiation therapy – Radiation therapy is the treatment of
cancer using penetrating beams of high-energy waves or streams
of particles. This is called radiation, and when used in high
doses, can kill cells or keep them from growing and dividing.
Normal cells are also affected by radiation, but unlike cancer
cells, most of them recover from the effects. Radiation therapy
is often used with surgery to treat cancer. CHOC specialists may
use radiation before surgery to shrink a tumor. This makes it
easier to remove the cancerous tissue and may allow the surgeon
to perform less radical therapy.
Surgical Services
Surgery also may be included in this “roadmap.” Patients
at The CHOC Cancer Institute have direct access to the full range
of surgical specialties including pediatric surgery, neurosurgery,
ENT surgery, urology, orthopedic and thoracic surgery. All surgical
services are child- and adolescent-centered, with surgeons and
nurses specially trained to operate on children. Surgery can involve
removing the tumor, or taking some tissue for a biopsy. It is
often used in conjunction with chemotherapy and/or radiation to
help remove as much of the cancer as possible.
For more information about The CHOC Institutes,
please
email us at institutes@choc.org
or call (800) 329-2900.
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